Chronic kidney disease in disadvantaged populations.

The increased burden of chronic kidney disease (CKD) in disadvantaged populations is due to both global factors and population-specific issues. Low socioeconomic status and poor access to care contribute to health care disparities and exacerbate the negative effects of genetic or biological predisposition. Provision of appropriate renal care to these populations requires a two-pronged approach: expanding the reach of dialysis through development of low-cost alternatives that can be practiced in remote locations, and implementation and evaluation of cost-effective prevention strategies. Kidney transplantation should be promoted by expansion of deceased donor transplant programs and use of inexpensive, generic immunosuppressive drugs. The message of World Kidney Day 2015 is that a concerted attack against the diseases that lead to end-stage renal disease, by increasing community outreach, better education, improved economic opportunity, and access to preventive medicine for those at highest risk, could end the unacceptable relationship between CKD and disadvantage in these communities.

[Genetic testing, prevention and health care insurance markets]. / Tests génétiques, prévention et marchés d'assurance santé

Since this special issue of medecine/sciences is devoted to personalized medicine, it seems unnecessary for two economists to summarize or discuss, from a medical perspective, recent advances in genetic research. We rather focus on the consequences of improved genetic testing on the health insurance market, on how this market may be affected and on the degree of coverage offered to consumers according to the regulations implemented. More precisely, we first study the value of the information conveyed by genetic tests and we then decompose this value into several components according to the regulations implemented in various health insurance markets.

Insurance coverage and anticipatory guidance: are Hispanic children at a disadvantage?

We examined pediatric insurance status and receipt of weight-related anticipatory guidance in the 2008-2010 Medical Expenditures Panel Survey (n = 12,438). Hispanic children were more likely than white children to report diet and exercise counseling, regardless of insurance. Given the risks of overweight and obesity among Hispanic children, these findings are promising.

The role of international remittances in health outcomes in Ecuador: prevention and response to shocks.

This article evaluates the impact of remittances on health outcomes in Ecuador using an instrumental-variables approach. Although we do not find significant impacts on long-term child health variables, we find that remittances do have an impact on health expenditures, and on some preventive issues such as de-worming and vaccination. In addition, we find significant effects of remittances on medicine expenditures when illness occurs. In this regard, remittances are used for both preventive and emergency situations. Interestingly, we also find a significant and positive effect of remittances on health knowledge.

Cacophonies of aid, failed state building and NGOs in Haiti: setting the stage for disaster, envisioning the future.

The January 2010 earthquake in Haiti was a catastrophe not only for the loss of life it caused, but also because it destroyed the very thin layer of state administrative capacity that was in place in the country. This article argues that the fragility of the Haitian state institutions was exacerbated by international strategies that promoted NGOs as substitutes for the state. These strategies have generated a vicious circle that, while solving immediate logistical problems, ended up weakening Haiti's institutions. However, the article does not call for an overarching condemnation of NGOs. Instead, it explores two cases of community-based NGOs, Partners In Health and Fonkoze, that have contributed to creating durable social capital, generated employment and provided functioning services to the communities where they operated. The article shows that organisations that are financially independent and internationally connected, embrace a needs-based approach to their activities and share a long-term commitment to the communities within which they operate can contribute to bringing about substantial improvement for people living in situations of extreme poverty. It concludes that in the aftermath of a crisis of the dimension of the January earthquake it is crucial to channel support towards organisations that show this type of commitment.

[Research and cure: knowledge and prophylaxis of endemic goiter in Argentina (1916-1958).]. / Investigar y curar: conocimientos y profilaxis del bocio endémico en la Argentina (1916-1958).

The present paper focuses on the reconstruction of the historical circumstances of knowledge production as well as and the debates about endemic goiter disease during the period 1916-1955 in Argentina. Taking into account the social, political and material dimensions, this text explores the re-signification of scientific and medical knowledge oriented to the prevention and health treatment, through the positioning of several social actors engaged all along the period, and the diverse historical and institutional contexts.

[Myths about the prevention and control of non-communicable diseases in Latin America]. / Mitos sobre la prevención y el control de las enfermedades no transmisibles en América Latina.

Given the increase of the burden of non-communicable diseases (NCD) and the possibility to avoid it, it is urgent to implement or strengthen NCD preventive programs in Latin America. However, many myths hinder the implementation of NCD programs. Myths on NCD include: a) NCD are degenerative and incurable; b) they are diseases of the elderly; c) they are diseases of the rich. Like wise there are myths about NCD preventive programs are: a) difficult to implement, b) expensive, and c) ineffective. We present data that demonstrate how these myths are untrue and discuss the challenges to find a balanced health policy that emphasizes the importance of NCD without overlooking other diseases.

The selling of preventive medicine: ethical, fiscal and political imperatives - abstract

After years of paternalistic prescriptions and peer pressure, it is clear that physicians, like most people, act in what they perceive to be their best (financial) interest. The underlying principles whereby physicians can be persuaded to change their professional behaviour are the same as when a patient is convinced first to swallow an initial dose of medicine, and then to carry out the entire treatment plan. Firstly, the patients/physicians have to accept that they have a problem/condition. Secondly, they believe the problem-solver is trustworthy and qualified to solve it. Thirdly, they understand the rationale for the prescription enough to try the first dose. Finally, they get sufficient results or encouragement to finish the course of treatment. One common difficulty of physicians is that they underestimate the importance of the first and second steps: most of the patients we see already acknowledge them, but getting our colleagues to swallow medicine is another matter! It is therefore not surprising that, while we all agree on the importance of preventive medicine, immunization and smoking cessation programmes never get the whole-hearted support of physicians until there is a positive (financial) incentive to do so. The fee-for-service system actually penalizes the early resolution or prevention of health problems, and defensive medicine practices are more costly than malpractice premiums. Thus the major goals of health care reform in the U.S. are to provide positive incentives to reduce visits to the doctor and the hospital, and to reduce fear of lawyers, among providers. At the same time, there need to be safeguards to ensure that quality of care and access by the poor and truly sick are not adversely affected. It is also apparent that preventive medical initiatives are most effective when the responsibility for follow-through is given to Public Health Nursing. There is no shortage of experienced nurses willing to assist consumers to reduce their visits to the doctor, dentist and hospital. We just have to pay what these services are worth in savings to the health care system (AU_

Utilizaçäo hospitalar no Brasil e o efeito de medidas de contençäo do crescimento de hospitalizaçoës / Hospital utilization in Brazil and the effect of the measures to restrain the increase of hospitalizations

O propósito deste trabalho é o de analisar o crescimento e variaçäo das internaçöes hospitalares no Brasil, bem como discutir os efeitos de recentes medidas governamentais destinadas a conter o crescimento acelerado da utilizaçäo hospitalar no país. Uma destas medidas refere-se ao método de pagamento hospitalar (pagamento por procedimento ou caso), introduzido no final de 1983, que, ao que parece, contribuiu para aumentar e näo diminuir a taxa de internaçöes. Por outro lado, os dados mostram que, recentemente, tem havido maior utilizaçäo dos hospitais públicos, já que houve aumento do número de hospitalizaçöes nestes hopsitais. Os resultados mostram, também, que existe grande diferença na produçäo de serviços entre hospitais públicos e privados. Ao operarem maciçamente com internaçöes da especialidade de clínica médica, os hospitais privados podem estar tratando os casos mais simples, enquanto os hospitais públicos parecem cuidar dos casos mais complicados, dado o elevado percentual de internaçöes na especialidade de clínica cirúrgica